Rales in Lungs After Pneumonia

Yesterday I went to my doctor because I had a bad cold with a cough. She checked my lungs and said I had rales in my lower right lobe and was concerned that I had congestive heart failure and did blood work to check for same. I did have a bad case of pneumonia in January (also had the same thing the previous year), and ended up with some nodules in my lungs. My pulmonologist does CT scans every six months to keep them checked. When I was examined by her in April, she too, heard rales in my lungs (side that the pneumonia was in.) She didn't seem concerned about it. But now I am very upset about the suggested CHF. I have no other symptoms, no edema or shortness of breath. I had a complete work-up June 30 at Joslin Diabetic Clinic, and all the blood work was fine including the kidneys. I do my treadmill every day with no trouble breathing. I would like some opinions on this.

The rales could be a residual of pneumonia and of no consequence. Your lack of symptoms is a very good sign. This is evidence against congestive heart failure (CHF) being a problem. The presence of rales without other typical findings is not enough to say that you have congestive heart failure.

For starters, you should have a chest x-ray to check your heart size. If the heart was not enlarged on your recent CT scan, that would suffice. If congestive heart failure remains a concern, you should have an electrocardiogram (EKG) and an echocardiogram. The echocardiogram will tell for sure if congestive heart failure is the problem.

Finally, you should ask for your pulmonologist's opinion about the cause of the rales. Also ask about the appearance of that portion of lung on the last lung CT scan. It is uncommon for an otherwise healthy adult to have documented recurrent pneumonia. If the pneumonia was in the same portion of lung each time that raises the question of a structural problem or a foreign body in that portion of lung. If recurrent, but not in the same location, that raises other questions about your immune status or aspiration pneumonia. You should talk about this with your pulmonologist. Ask specifically if the rales could be a sign of pulmonary fibrosis.

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